Provider Demographics
NPI:1467756957
Name:MOORE, ASHLEY GLEE (MCP, LCPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GLEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MCP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N TYLER RD
Mailing Address - Street 2:APT 1314
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3676
Mailing Address - Country:US
Mailing Address - Phone:316-651-6376
Mailing Address - Fax:
Practice Address - Street 1:505 N TYLER RD
Practice Address - Street 2:APT 1314
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3676
Practice Address - Country:US
Practice Address - Phone:316-651-6376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health